tbuckley/cabot-search huggingface dataset:
Abstract 9853: Trends in National Death Rates From Heart Disease in the United States, 2010–2020
Authors: Rebecca C Woodruff, Xin Tong, Sandra L Jackson, Fleetwood V Loustalot, Adam S Vaughan
Journal: Circulation (2022)

Introduction: Heart disease (HD) death rates have been declining for decades. Updated trend data for 2010–2020 are needed to inform clinical and public health practice. Methods: We obtained age-standardized death rates per 100,000 population from the US Centers for Disease Control and Prevention’s WONDER database, which aggregates death certificate data from the National Vital Statistics System. Among adults aged ≥35 years, HD deaths were defined by underlying cause of death International Classification of Diseases, 10th revision codes. We calculated percent change between 2010, 2019, and 2020 death rates overall and by HD subtypes and demographic subgroups. Results: HD death rates declined during 2010-2019 and increased in 2020 across age, sex, and race and ethnicity groups. The national HD death rate declined by 9.8% from 2010 to 2019 (347.3 vs. 313.0 per 100,000) and increased by 4.1% in 2020 to 325.9 per 100,000, which approximated the 2015 rate (326.5 per 100,000). Coronary heart disease accounted for 55% of total HD deaths in 2020. Among non-Hispanic Black adults, the HD death rate declined by 10.4% during from 2010 to 2019 and increased by 11.2% in 2020, returning the 2020 HD death rate (440.7 per 100,000) to approximately the 2010 rate (442.4 per 100,000). Among adults aged 35–54 and 55–74 years, HD death rates declined from 2010 to 2019 (35–54: 5.5%, 55–74: 2.3% decline) and increased in 2020 (35–54: 12.0%, 55–74: 7.8% increase), resulting in a higher HD death rate in 2020 (35–54: 54.1, 55–74: 297.3 per 100,000) than in 2010 (35–54: 51.1, 55–74: 282.5 per 100,000). Conclusions: National declines in HD death rates had reversed by 2020 during the Coronavirus Disease-2019 pandemic. Setbacks represented approximately 5 years of lost progress among all adults and ≥10 years of lost progress among non-Hispanic Black adults and younger adults. Clinical and public health efforts may need to be modified to reverse negative trends in HD mortality.
Abstract 9851: Lnc <i>APAT</i> Promotes Lipid Phagocytosis and Monocyte Adhesion in Atherosclerosis Through miR-107/NOR1 Axis
Authors: Adalaiti Kamili, Shuang Han, Yu Chen, Weili Zhang
Journal: Circulation (2022)

Introduction: Atherosclerosis is a chronic inflammatory disorder characterized by excessive lipid deposition in the arterial intima. MicroRNA (miR)-107 was reported to inhibit the development of atherosclerosis, but it is unclear whether miR-107 regulate lipid phagocytosis of macrophages. Hypothesis: In the present study, we hypothesized that the potential interaction of lncAPAT and miR-107 may regulates the development of atherosclerosis. Methods and results: We used real-time quantitative PCR (RT-qPCR) to determine the expression levels of miR-107 in peripheral blood mononuclear cells (PBMCs) from patients with coronary artery atherosclerosis and control subjects without plaque. Bioinformatics analysis, dual-luciferase reporter and RNA immunoprecipitation (RIP) assays were used to verify the interaction between lncRNA atherosclerotic plaque instability-associated transcript (lnc APAT ) and miR-107. We found that miR-107 was highly expressed in the PBMCs of patients with atherosclerotic plaques, and that lnc APAT acted as a competing endogenous RNA to decrease the expression of miR-107. In addition, miR-107 inhibited monocyte adhesion and lipid phagocytosis of macrophages, while lnc APAT promoted monocyte adhesion and lipid phagocytosis via binding with miR-107. Further experiments identified neuron-derived orphan receptor 1 (NOR1) as a downstream target of miR-107 that was up-regulated by lnc APAT . In vitro and in vivo studies revealed that lnc APAT promoted monocyte adhesion and lipid phagocytosis of macrophages by functioning as a ceRNA to up-regulate NOR1 by sponging miR-107. Conclusions: Our study demonstrates that lncAPAT regulates the miR-107/NOR1 axis to promote lipid phagocytosis by macrophages, indicating that it may serve as a potential therapeutic target for atherosclerotic disease.
Abstract 9927: Insufficient Monitoring and Inaccurate Evaluation Characterize the Heart Failure Symptom Perception Process
Authors: Solim Lee, Amy Nolan, Julie Guerin, Brittany Koons, Lea Ann Matura, Corrine Y Jurgens, Victoria V Dickson, Barbara Riegel
Journal: Circulation (2022)

Perceiving symptoms is needed before one can respond to symptoms, but little is known about the difficulties experienced by patients with heart failure (HF) as they engage in the complex processes of symptom monitoring, awareness, and evaluation. Aim: To explore difficulties in symptom perception and describe the characteristics of patients who consistently perceive HF symptoms. Methods: Using a convergent mixed methods design, we enrolled a purposeful sample of 40 adults with an unplanned hospitalization for HF symptom exacerbation. Quantitative data were obtained from the electronic health record and the Self-Care of Heart Failure Index (SCHFI v 7.2, scale scores 0-100, higher score = better self-care). Qualitative data from 1:1 semi-structured interviews exploring the symptom perception process were analyzed using directed content analysis. For data integration, individual difficulties in the SCHFI symptom perception processes of monitoring, awareness, and evaluation were anchored on the qualitative data. Two groups with different symptom perception consistency were identified from interviews. Group differences were examined using independent T, Mann-Whitney, Chi 2 , and Fisher’s Exact tests. Results: The sample was 50% male, 45% non-white, mean age 62 years, and 75% NYHA III-IV. Most (72.5%) demonstrated adequate symptom perception (SCHFI score ≥70). The consistent symptom perception group (n=27, 67.5%) had no difficulties in symptom monitoring, awareness, and evaluation while the inconsistent group reported insufficient symptom monitoring and/or inaccurate symptom evaluation. The consistent group was more experienced with HF and visited the emergency department more frequently in the past year. There were no group differences in age, gender, race, NYHA class, and HF stage (Table 1). Conclusion: Symptom perception interventions may be particularly useful early in the HF trajectory to enhance symptom monitoring and evaluation abilities.
Abstract 9913: Possible Disparities in Outcomes Among Patients With Hearing Loss Admitted for Acute Myocardial Infarction
Authors: Kamleshun Ramphul, Renuka Verma, Nomesh Kumar, Shaheen Sombans, Yogeshwaree Ramphul, Komal Kumari, Jyotsnav Joynauth, Fnu Arti, Petras Lohana
Journal: Circulation (2022)

Introduction: Patients with hearing loss (HL) experience different levels of difficulties throughout their lives, impacting their quality of care. Little is known about the outcomes of patients with hearing loss following admission for Acute Myocardial Infarction (AMI). Method: Patients with a principal diagnosis of AMI and patients with any form of HL were recruited in our study from the 2019 National Inpatient Sample (NIS). Various comorbidities were studied. Results: Our analysis found 14,100(2.1%) AMI cases with HL diagnosis. The majority of the patients were Males (64.5%, p&lt;0.01) or Whites (84.4%, p&lt;0.01). HL patients also showed a higher number of various comorbidities as 89.0% had hypertension, 74.3% had hyperlipidemia, and 23.8% had acute kidney injury. Meanwhile, HL patients had a lower prevalence of diabetes (40.0%), using cannabis (0.7%), and smoking (46.8%). HL patients were also less likely to undergo Coronary artery bypass graft surgery (CABG) (5.8% vs.7.5%, OR:0.763, p&lt;0.01) or Percutaneous coronary intervention (PCI) (35.0% vs. 45.2%, OR 0.651, p&lt;0.01). They also reported more cases of several cardiac arrhythmias as 3.2% of patients also experienced supraventricular tachycardia, and 15.4% had paroxysmal atrial fibrillation. In comparison, HL patients showed a lower rate of ventricular fibrillation (2.0% vs. 3.3%). However, a slightly higher risk of mortality (aOR: 1.104, 95% CI 1.021-1.194, p=0.013) was found among all HL patients (5.4%) with AMI compared to non-HL patients (4.5%). Conclusion: Our study raises several concerns about the outcomes of HL patients following admission for AMI. In the acute setting, patients with HL may not be able to provide adequate information about their symptoms and their medical history, which can predispose them to a poorer prognosis. We, therefore, encourage hospitals to improve communication for HL patients via easier access to ASL translators in different hospital settings.
Abstract 9933: Shifting Paradigms in Rhythm versus Rate Control in Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials
Authors: Jong Kun Park, Muhammad Bajwa, Jin wan Kim, Luis L Novelo, Tarif Khair
Journal: Circulation (2022)

Introduction: Atrial fibrillation is the most common cardiac arrhythmia and is an independent risk factor for mortality across a wide age range in both men and women. Management methods of atrial fibrillation have been thoroughly investigated through numerous trials exploring various treatment modalities. There has been a preference for rate control as the initial approach, but recent studies, particularly the EAST-AFNET 4 trial, point out several clinical settings in which rhythm control is preferable. To evaluate new paradigms in the acute management of atrial fibrillation, our meta-analysis provides a current, curated examination of the major landmark trials in the management of atrial fibrillation along with the most recent randomized controlled trials that have been published since 2022. Methods: A literature search was performed on May 2022 using PubMed and OVID Medline databases for study identification. Combinations of the search terms atrial fibrillation, rate control, adrenergic beta antagonists, rhythm control, anti-arrhythmia drugs, and catheter ablation were combined to conduct the literature search. Boolean operators AND and OR were used to combine terms. Results: There were no significant differences in the effects of rate and rhythm control on any outcome: all-cause mortality (RR: 0.996; CI: 0.674-1.376), cardiovascular mortality (RR: 0.957; CI: 0.601-1.413), arrhythmic/sudden death mortality (RR: 0.954; CI: 0.445-1.816), stroke/transient ischemic attack (RR: 1.011; CI: 0.535-1.78), and systemic embolism (RR: 1.275; CI: 0.541-2.625). Conclusions: Updated data pooled from randomized control trials in patients with atrial fibrillation suggests that rhythm and rate control strategies have no statistically significant differences on major clinical outcomes. Additional studies will be required to investigate factors favorable for rhythm-control strategies and to determine contemporary best clinical practices.
Abstract 9818: Use of Outpatient Intravenous Diuretic Therapy Among Patients With Heart Failure in the United States
Authors: Stephen J Greene, Daisuke Goto, Dong Wang, Dominik Lautsch, Robert J Hilkert, Gregg C Fonarow
Journal: Circulation (2022)

Introduction: Select centers have published local experiences with outpatient (OP) intravenous (IV) diuretic clinics to treat worsening heart failure (HF) and prevent hospitalization. Little is known regarding widespread use of this care strategy in contemporary US practice, including the potential impact of the COVID-19 pandemic. Methods: Inpatient (IP) and OP claims from Optum (April 2018-March 2021) were utilized to identify instances where patients with HF with reduced ejection fraction (HFrEF) received ≥1 administration of IV diuretic. Episodes of care were categorized into hierarchical mutually exclusive groups defined by intensity of care setting, including IP hospitalization, critical care (without IP hospitalization), emergency department (without IP hospitalization), observation unit, nursing facility, and outpatient clinic. Analyses were stratified across pre-pandemic (4/2018-3/2019, 4/2019-3/2020) and COVID-19 pandemic periods (4/2020-3/2021). Results: Among 302,397 patients with HFrEF, 56,213 (19%) patients received IV diuretic therapy during the study period, accounting for 94,865 total IV diuretic episodes. Of patients receiving IV diuretics, 44% were female and 20% were Black. Among 85,827 (90%) IV diuretic episodes with available data on location of care, 14% were outpatient clinic visits, 60% were IP hospitalizations, and 21% were ED visits. Critical care, observation unit, and nursing facility locations each constituted ~1-2% of IV diuretic episodes. The proportion of outpatient IV diuretic visits and the overall distribution of IV diuretic episodes was similar over time, spanning the pre-pandemic and COVID-19 pandemic periods (Figure) . Conclusions: In this cohort of US patients with HFrEF, approximately 1 in 7 care episodes involving IV diuretic therapy occurred in outpatient clinic. The relative proportion of outpatient IV diuretic visits did not meaningfully change during the first year of the COVID-19 pandemic.
Abstract 9978: Non-Traditional Risk Markers for Incident Coronary Artery Calcium Among Persons ≥65 Years Old: The Multi-Ethnic Study of Atherosclerosis
Authors: Alexander C Razavi, Omar Dzaye, Erin D Michos, Matthew J Budoff, Norrina B Allen, Joao A Ac Lima, Joseph F Polak, Wendy S Post, Khurram Nasir, Roger S Blumenthal, Laurence Sperling, Seamus P Whelton
Journal: Circulation (2022)

Introduction: Initiation of coronary artery calcium (CAC) is an important milestone associated with a marked increase in cardiovascular disease (CVD) risk. However, traditional risk factors do not perform well for CVD risk stratification among older persons. Hypothesis: Contrasting to measures of subclinical CVD, blood-based non-traditional risk factors will not strongly predict incident CAC in older adults. Methods: There were 815 participants &gt; 65 years old with CAC=0 at Visit 1. We calculated multivariable Cox hazards ratios and C-statistics for the association of non-traditional risk factors with incident CAC. Results: The mean age was 70.2 years old, 67% were women, and 35% were Black. A total of 55% developed incident CAC with a median follow-up time to incident CAC of 3.6 years. The largest proportion of persons with incident CAC was among those with microalbuminuria (Figure). Albuminuria (aHR=1.54, 95% CI: 1.10-2.16) and thoracic calcification (TAC) (aHR=1.38, 95% CI: 1.10-1.75) were significantly associated with incident CAC, while 1-SD higher level of apolipoprotein-B, lipoprotein(a), high-sensitivity troponin T, N-terminal pro-brain natriuretic peptide and C-reactive protein were not. When added to demographic information, albuminuria and TAC provided a greater C-statistic improvement (+0.044, p=0.01) versus all traditional risk factors combined (+0.029, p=0.09). Conclusions: Among non-traditional risk factors and measures of subclinical CVD, only albuminuria and TAC were significantly associated with incident CAC in persons &gt;65 years old. Identification of older persons with albuminuria or TAC may help guide the utility and timing of repeat CAC scoring in older persons with baseline CAC=0.
Abstract 9886: Outcome of Pancreatic Cancer Patients Following Hospitalization for Acute Myocardial Infarction: Perspective From the National Inpatient Sample
Authors: Nomesh Kumar, Renuka Verma, Kamleshun Ramphul, Stephanie G Mejias, Shaheen Sombans, Komal Kumari, Yogeshwaree Ramphul, Fnu Arti, Petras Lohana
Journal: Circulation (2022)

Introduction: Pancreatic cancer (PC) has induced a higher risk of a hypercoagulable state that can further lead to various complications such as Acute Myocardial Infarction (AMI). There is a lack of data on the outcomes of PC patients following an episode of AMI. Method: A retrospective analysis was performed via the 2019 National Inpatient Sample (NIS). We identified a principal diagnosis of AMI and a diagnosis of PC (ICD-10 'C25.x') at any level. Patient characteristics (sex, race, diabetes, mean age, hypertension, hyperlipidemia, and smoking history) were compared, and the risk of mortality in PC patients was estimated via multivariable regression analysis. Results: In total, 555 (0.1%) PC cases were found among all hospitalized cases of AMI in the United States in 2019. We also found that 63.1% were males, 46.8% had diabetes, 85.6% had hypertension, 58.6% had hyperlipidemia, 45.9% reported a smoking history, and 73.0% were Whites. Among the PC patients, 120 (22.4%) patients underwent PCI. Unfortunately, 65 (11.7%) patients with PC died (aOR 2.595, 95% CI 1.995-3.375, p&lt;0.01). Among PC patients with AMI, a lower mortality risk was seen among smokers (aOR: 0.221, 95% CI 0.110-0.444, p&lt;0.01), diabetics (aOR: 0.369, 95% CI 0.193-0.707, p&lt;0.01), and those with hypertension (aOR: 0.114, 95% CI: 0.054-0.239, p&lt;0.01). The mean age of all PC patients was 72.77 years (SEM: 0.421), while non-PC patients were younger (66.92 years, SEM:0.016). PC patients that died were also older, with a mean age of 75.38 (SEM:1.542), compared to non-PC patients that died following AMI (mean age 73.41, SEM 0.071). Conclusion: Our analysis found that pancreatic cancer raised the risk of mortality among AMI cases. While most cases of pancreatic cancer tend to have an overall poor prognosis, physicians are encouraged to investigate further other risk factors that can complicate their hospitalizations.
Abstract 9847: Association of Stroke and CHADSVASc With Left Atrial Scar in Patients Undergoing Catheter Ablation for Atrial Fibrillation
Authors: Justin Devera, Wilson Kwan, Matthew Mendoza, Andrew Zadeh, Ivan C Ho, Junaid Zaman
Journal: Circulation (2022)

Introduction: Recurrent atrial fibrillation (AF) is estimated to occur in at least 20% of patients with paroxysmal or persistent AF who undergo catheter ablation (CA). Recent studies have suggested that extent of left atrial (LA) scar is of prognostic value, but it is unknown whether there is an association with patient co-morbidities. Hypothesis: Patients with structural heart disease or prior thromboembolic events have more LA scar and greater risk of AF recurrence. Methods: We retrospectively studied 117 patients who underwent CA for AF at our institution. Only ablations using the same method for radiofrequency ablation of pulmonary vein antra were included. We evaluated the association between demographic variables, LA volume, history of stroke, AF recurrence (defined as AF relapse more than 3 months after CA) and LA scar quantified by 3D electroanatomic mapping using simple regression and Kaplan-Meier analyses. Results: Mean age was 64 years, 68% were male, 60% had paroxysmal AF, 34% had persistent AF, and 6% had long-standing persistent AF. Recurrence of AF occurred in 22% of patients overall, and was significantly associated with systolic heart failure (HF) (p=0.042), number of prior cardioversions (CV) (p=0.014), left ventricular ejection fraction (LV EF) (p=0.02), LA volume (p=0.032), and atrial flutter (p=0.014). Total LA scar was significantly associated with CHA2DS2-VASc score (p=0.0095) and history of stroke or transient ischemic attack (TIA) (p=0.031). Conclusion: AF recurrence is more likely to occur in patients with LV dysfunction, prior CV, increased LA volume, and atrial flutter during CA. Total LA scar was not associated with clinical AF recurrence. However, we demonstrate a new association between LA scar burden, CHA2DS2-VASc score and history of stroke or TIA. This may explain why patients do not need to be in AF at the time they develop thromboembolic events, as enduring LA scar may contribute to the pathogenesis of stroke.
Abstract 9934: Albuminuria Entails Myocardial Fibrosis at the Population Level: The MESA STUDY
Authors: Omar Chehab, Ralph Zeitoun, Mahsima Shabani, Vinithra Varadarajan, Collin Wu, Bharath Ambale Venkatesh, Norrina B Allen, Wendy S Post, Kamal Badr, Joao A Ac Lima
Journal: Circulation (2022)

Introduction: Microalbuminuria(MA) is an established predictor of CVD. Experimental and small observational studies have shown an association between MA and myocardial fibrosis(MF) among patients with type two diabetes mellitus (DM). However, the relationship to MF in a community-based population is unknown. Hypothesis: We hypothesize that participants with MA will have higher rates of MF measured by cardiac magnetic resonance T1(CMR-T1) mapping. Methods: A total of 1,010 men (mean age:68±9) and 1,003 women (mean age: 70 ± 9) who had both urine albumin and creatinine measurements and CMR-T1 for evaluation of MF were included in MESA visit 5. To study the association of MA among various populations, analyses were then stratified by diabetes stage and by sex. Multivariable linear regression models were constructed to assess the associations of MA with ECV and native T1 time. Results: Higher levels of MA were independently associated with greater evidence of MF (Fig.A). Participants with worse severity of MF (defined as ECV &gt;30%), that were men, or had either history of pre-DM or DM had significantly higher levels of MA, whereas no difference in MA levels were found in women (Fig.B). Among men only, each 1-SD increment greater MA levels was significantly associated with 0.3% higher ECV and 2.6% higher native T1. Among participants with pre-diabetes and diabetes, each 1-SD increment in MA levels was associated with 0.4% and 0.3% higher ECV and 3% and 3.5% higher native T1, respectively (Fig.A) Conclusions: In a community-based setting, measurable MA, independent of age, sex, DM, history of CVD, and other clinical variables, was related to subclinical MF. This association was more significant among participants with preDM, Type2DM, and men. These findings demonstrate that MA, a urine biomarker, may identify participants with high subclinical profibrotic condition. Further studies are warranted to address whether treatment of MA will be associated with lower MF.
Abstract 9824: Cardiovascular Complications During Delivery Admissions Associated With Systemic Lupus Erythematosus: A National Inpatient Sample Analysis (2004-2019)
Authors: Salman Zahid, Mohamed Salah Mohamed, heba wassif, Noreen Nazir, Sadiya S Khan, Erin D Michos
Journal: Circulation (2022)

Introduction: Persons with systemic lupus erythematosus (SLE) have an increased risk of obstetric-associated complications. However, data on acute cardiovascular (CV) complications during delivery remain limited. Hypothesis: SLE is associated with increased acute CV complications at the time of delivery. Methods: We used data from the National Inpatient Sample (2004-2019) while utilizing ICD-9 or ICD-10 codes to identify delivery hospitalizations and a diagnosis of SLE. Results: A total of 63,037,442 weighted delivery hospitalizations were identified, of which 0.1% were among persons with SLE (n=77,560). Individuals with SLE were older (median 30 vs. 28 years, p&lt;0.01) and had a higher prevalence of polycystic ovary syndrome (PCOS), gestational diabetes mellitus (GDM), obesity, and dyslipidemia (p&lt;0.01). After adjustment for age, race/ethnicity, comorbidities, insurance, and income, SLE remained an independent predictor of peripartum CV complications including preeclampsia (aOR 2.12 [2.07-2.17]), peripartum cardiomyopathy (aOR 4.42 [3.79-5.13]), heart failure (aOR 4.06 [3.61-4.57]), and cardiac arrhythmias (aOR 2.06 [1.94-2.21]) compared with no SLE. Likewise, the risk of acute kidney injury (AKI), stroke, pulmonary edema and venous thromboembolism (VTE) were higher with SLE. An overall increasing trend of obesity, GDM and PCOS was also observed among individuals with SLE. For resource utilization, length of stay and cost of hospitalization was higher for deliveries among persons with SLE. Conclusions: Persons with SLE had a higher risk of preeclampsia, peripartum cardiomyopathy, heart failure, arrhythmias, pulmonary edema, AKI, stroke and VTE during delivery hospitalizations. Furthermore, cardiometabolic risk factors among individuals with SLE are on the rise over this 15 year period.